Provider Demographics
NPI:1114165990
Name:GRIFFIN, KATIE L (MA, LPC, CGP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MA, LPC, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 MARATHON BLVD
Mailing Address - Street 2:SUITE 200C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3719
Mailing Address - Country:US
Mailing Address - Phone:512-656-4067
Mailing Address - Fax:
Practice Address - Street 1:4103 MARATHON BLVD
Practice Address - Street 2:SUITE 200C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3719
Practice Address - Country:US
Practice Address - Phone:512-656-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-01
Last Update Date:2009-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional